The Division of Neurosurgical Anesthesiology has been providing innovative care to our patients with neurologic disease. The perioperative management of patients undergoing Neurosurgical procedures requires the knowledge of neuroanatomy, cerebral physiology, effects of anesthetic agents on cerebral pathophysiology, neurological monitoring and management of intracranial hypertension and cerebral edema.
The group of physicians providing care under the auspices of the division is specialty trained in Neuroanesthesiology with much diversified clinical interests.
- Director: David Schreibman, MD, Assistant Professor
- Beatrice Afrangui, MD, Clinical Assistant Professor
- Caron Hong, MD, MSc, Associate Professor
- Douglas Martz, MD, Associate Professor
- Vadivelu Sivaraman, MBBS, Assistant Professor
University of Maryland / Shock Trauma Center Operating Rooms
In the operating rooms, the Division of Neurosurgical Anesthesiology provides care for neurosurgical patients, including management of patients undergoing cerebrovascular surgery, benign and malignant intracranial tumors, transsphenoidal pituitary surgery, stereotactic procedures, spinal surgery, epilepsy surgery, evacuation of cerebral hematomas and complex spinal surgery. Last year, care was provided for over 1500 neurosurgical patients, including approximately 100 neurovascular procedures.
Neurosurgical Intensive Care
The Neurocare ICU is a ten-bed critical care unit. It is operational twenty-four hours a day and staffed full-time by the faculty of the Division of Neuroanesthesiology. The unit provides critical care and recovery services in a customer-focused, cost-effective environment to patients with neurological impairment. The interdisciplinary team approach utilized in the unit educates both the patient and the family regarding the disease process, the treatment plan and the expected outcome.
Intraoperative Neurophysiologic Monitoring Service
The Intraoperative Neurophysiologic Monitoring service aims to identify new intraoperative neurological impairment to allow for prompt correction, provide functional guidance to the surgeons and ultimately the best patient outcomes. The service is medically directed by David Schreibman M.D. and supervised by Bryan Ferguson CNIM, a recognized expert in neuromonitoring. Most of the technical staff is certified as CNIM, Certification for Neurophysiologic Intraoperative Monitoring, awarded by the American Board of Electroencephalographic and Evoked Potential Technicians to designate technical excellence. Last year, the service monitored over 900 cases mostly involving the Neurosurgery, Orthopedic Surgery, Otolaryngology and Vascular Surgery services. Neuromonitoring modalities employed include:
- Somatosensory Evoked Potentials
- Cortical Evoked Potentials
- Brainstem Auditory Evoked Potentials
- Visual Evoked Potentials
- Cortical Mapping
- Pedicle Screw Stimulating
The Division of Neuroanesthesiology administers anesthesia that assists the Neuroradiologist to provide interventional therapeutic management of vascular disease involving the central nervous system using the latest minimally-invasive techniques. Last year, we provided anesthesia support for over 100 aneurysm coilings and an assortment of other neurovascular procedures.
Neuroanesthesiology Research Opportunities
Many of the faculty are actively involved in clinical and basic science research projects. The Intraoperative Neurophysiologic Monitoring Service has ongoing projects related to the monitoring of the neurologic system during various procedures. The University of Maryland is among the top twenty institutions in research grant expenditures and there is also the ability for interested fellows to participate within the Department’s Research activities specializing in neuroprotection or collaborate with other basic science laboratories on campus that might interest them.
Neuroanesthesiology Residency Training
The Division of Neurosurgical Anesthesiology provides residents four months of exposure to clinical Neuroanethesiology. During their rotation the resident should:
- Learn neuroanatomy and physiology.
- Be able to develop a plan and provide anesthesia for a variety of various neurosurgical procedures – including craniotomy for tumors and neurovascular pathology, complex spine surgery and interventional radiology.
- Understand the effects of anesthetics on patients with intracranial pathology.
- Be able to assess and perform elective and emergent airway and ventilation management for patients with traumatic or structural cervical spine disease, subarachnoid hemorrhage and decreased intracranial compliance.
- Understand the physiology of neuromonitoring and how it applies to monitoring patients with cerebral or spinal pathology.
- Understand the perioperative management of patients with neuropathology including subarachnoid hemorrhage, intracerebral hemorrhage, spinal cord injury, neuroendocrine dysfunction and decreased intracranial compliance.
Neuroanesthesiology Fellowship Training
We offer the opportunity for specialized training over a minimum of twelve months in the perioperative management of patients undergoing neurological surgery and interventional neuroradiologic procedures. The fellowship is designed to provide the candidate an individualized learning experience designed to meet their professional goals. The clinical experiences in the neurosurgical operating room include providing anesthesia for a variety of complex neurosurgical procedures including cerebral aneurysm clipping, supratentorial and posterior fossa craniotomy for tumor excision, transsphenoidal hypophysectomy, epilepsy surgery, placement of a variety of neurostimulators and complex spine surgery. There are many opportunities to select elective rotations including Neurotrauma, neurosurgical critical care, neuromonitoring and neuro-radiology that allows you to individualize your training to meet your educational interests. The fellow is also encouraged to seek the opportunity to be involved in clinical or basic science research that interests them on the University of Maryland campus.